Vol 17, No 6 (2011)

Thirteen Moscow phthisiological facilities, including Moscow City Research-and-Practical Center for Tuberculosis (TB) Control, 4 TB hospitals, and 8 TB dispensaries having 24-hour hospitals, were comprehensively analyzed to have comparative characteristics of the work of TB hospitals and dispensaries over 12 years (1997-2008). Criteria were proposed for the efficiency of treatment in patients with pulmonary TB in the phthisiological facilities. According to the results of the study, hospital care includes as follows: bed occupancy and mortality rates and therapeutic effectiveness. The mean length of TB hospital stay for patients with active pulmonary TB has been found to be greater than the standard established by the Ministry of Health and Social Development of Russia (90 bed days) and equal to 90-100 bed days, including 90-110 bed days for patients with new-onset pulmonary TB. Along with this, the basic criteria for the efficiency of inpatient treatment should be considered to be bacterial excretion cessation and pronounced positive clinical and X-ray changes in the tuberculosis process.

The purpose of the trial was to study the delayed efficiency and safety of therapy with Ruzam (an inhaled formulation) in adult patients with mild and moderate persistent atopic asthma. The clinical, functional, and laboratory parameters of therapy (basic therapy in combination with Ruzam or placebo) were estimated in 63 patients with asthma 6 months after termination of a 2-week course of therapy. Therapeutic effectiveness was evaluated from the frequency of asthmatic attacks, needs for β2-agonists, the scope of basic therapy, and the degree of asthma symptoms according to patients' self-observation diaries, from peak flowmetry and spirometry readings, ACT scores, the level of allergic inflammatory markers, the values of bronchial hyperresponsiveness, and the frequency of acute respiratory viral infections (ARVI). Within 6 months after termination of the course of inhaled Ruzam therapy, asthmatic attacks were absent and clinical and functional control remained in 30 (97%) patients. There was a reduction in the total scope of basic therapy: the latter was discontinued in 12 (39%), the dose of the inhaled corticosteroid was halved in 5 (16%). In the control group receiving placebo (n = 32), the frequency of attacks and the level of asthma control remained as before; moreover, the scope of basic therapy could not be reduced; it was increased in 8 (25%) patients. There was a further significant reduction of the level of eosinophil cationic protein in the serum and sputum-induced supernatant, which was found in the Ruzam-treated patients immediately after the termination of the course of inhaled Ruzam therapy. Furthermore, the frequency of ARVI considerably declined in them.

The results of surgical treatment were analyzed in 274 patients with critical lower extremity ischemia. One hundred and seventy-seven patients underwent various vascular reparative interventions (femoral-popliteal bypass above (n = 92) and below (n = 16) the cleft of the knee joint, extended profundoplasty (n = 33), aortofemoral (n = 21), iliofemoral (n = 9), and crossover femoral-femoral (n = 6) bypasses). This all is assigned to direct extremity revascularization. Eighty-five patients underwent indirect revascularization (lumbar sympathectomy (n = 50), revascularing osteotrepanation (n = 35), and foot venous blood flow arterialization (n = 12). Direct revascularization yielded the best results that permitted an extremity to be preserved in 86% of the patients in the early postoperative period and in 78% a year after surgery.

Psychological testing in 82 patients with thyroid nodular goiter and cancer revealed psychoemotional disorders as phobic anxiety syndrome with the signs of depression. Prior to surgery, 43 of the patients received symptomatic therapy and 39 took, in addition to the latter, the benzodiazepine anxiolytic phenazepam. Incorporation of the latter into the preoperative preparation regime resulted in psychoemotional improvement and a reduction in the number of postoperative complications that did not relate directly to surgical techniques (subtotal thyroid resection, hemithyroidectomy, thyroidectomy) from 20.9 to 5.1%.

In 60 patients with erysipelas the levels of lipid peroxidation products (total polyenic, dienic conjugates, ketodienes and conjugated triens, Schiff bases) and the antioxidant defense system (the enzymatic activity of superoxide dismutase) were determined. The hemorrhagic form of erysipelas was most common (53.3%). The proportion of patients with recurrent erysipelas remains stably high (36.7%). Local purulent complications develop rather frequently (6.7%). A marked imbalance remained between the excessively activated lipid peroxidation processes and the insufficiently functioning antioxidant defense system remained throughout the disease.

The paper evaluates the efficiency of postabortion contraception methods used in obese women. It considers a release vaginal delivery system containing ethynylestradiol with ethonogestrel and an oral contraceptive containing ethynylestradiol and desogestrel. Estimation of biochemical blood parameters could establish the same impact of both methods on lipid metabolic parameters and great comfort when a release vaaginal delivery system was applied.